Health Outcomes from Home Hospitalization: Multisource Predictive Modeling.
J Med Internet Res
; 22(10): e21367, 2020 10 07.
Article
em En
| MEDLINE
| ID: mdl-33026357
ABSTRACT
BACKGROUND:
Home hospitalization is widely accepted as a cost-effective alternative to conventional hospitalization for selected patients. A recent analysis of the home hospitalization and early discharge (HH/ED) program at Hospital Clínic de Barcelona over a 10-year period demonstrated high levels of acceptance by patients and professionals, as well as health value-based generation at the provider and health-system levels. However, health risk assessment was identified as an unmet need with the potential to enhance clinical decision making.OBJECTIVE:
The objective of this study is to generate and assess predictive models of mortality and in-hospital admission at entry and at HH/ED discharge.METHODS:
Predictive modeling of mortality and in-hospital admission was done in 2 different scenarios at entry into the HH/ED program and at discharge, from January 2009 to December 2015. Multisource predictive variables, including standard clinical data, patients' functional features, and population health risk assessment, were considered.RESULTS:
We studied 1925 HH/ED patients by applying a random forest classifier, as it showed the best performance. Average results of the area under the receiver operating characteristic curve (AUROC; sensitivity/specificity) for the prediction of mortality were 0.88 (0.81/0.76) and 0.89 (0.81/0.81) at entry and at home hospitalization discharge, respectively; the AUROC (sensitivity/specificity) values for in-hospital admission were 0.71 (0.67/0.64) and 0.70 (0.71/0.61) at entry and at home hospitalization discharge, respectively.CONCLUSIONS:
The results showed potential for feeding clinical decision support systems aimed at supporting health professionals for inclusion of candidates into the HH/ED program, and have the capacity to guide transitions toward community-based care at HH discharge.Palavras-chave
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Base de dados:
MEDLINE
Assunto principal:
Serviços de Assistência Domiciliar
Tipo de estudo:
Etiology_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Aged
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Female
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Humans
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Male
Idioma:
En
Ano de publicação:
2020
Tipo de documento:
Article